Background: Hyperemesis gravidarum tends to rapidly progress into Wernicke encephalopathy and Korsakoff syndrome and, therefore, needs to be recognized early and managed promptly with targeted multimodal therapies. Objective: This study critically reviewed the relevant literature on clinical perspectives of hyperemesis gravidarum, Wernicke encephalopathy and Korsakoff syndrome. The secondary objective of this study was to improve the awareness, emphasis on early diagnosis and immediate intervention concerning these sequential syndromes in pregnant women across the board. Methods: Electronic searches (since inception-2019) of PubMed/MEDLINE, Google Scholar, OvidSP, Dove Medical Press, ScienceDomain International (SDI) and Hindawi.com were conducted using keywords and Boolean Operators. Hundreds of thousands articles were retrieved which were reviewed independently by two authors and finally 144 articles retained that addressed clinical components of these sequential syndromes along with relevance of thiamine deficiency. Results: Evidently, vulnerable women in early stage of gestation tend to develop hyperemesis gravidarum characterized by persistent severe pernicious nausea and vomiting that causes Wernicke encephalopathy defined by variable oculomotor disturbances, ataxia, confusion, metabolic disturbances and Korsakoff syndrome linked with gross memory impairment, confabulation and constipation. The women with these conditions need diagnostic evaluation by means of clinical history, relevant laboratory tests, abdominal ultrasound and brain computerized tomography and magnetic resonance imaging. Most patients need emergency admission, prompt treatment with optimal doses of antiemetics, vitamin B1, and followed by fluid replenishment and electrolyte balance with follow up till the end of pregnancy. Successful maternal and fetal outcome of pregnancy depends on multiple determinants including associated systemic diseases. Conclusion: Evidently, a variety of etiological and risk factors in pregnant women determine the initiation of hyperemesis gravidarum that subsequently causes Wernicke encephalopathy and Korsakoff syndrome, and each of which needs prompt multimodal treatment in order to reduce maternal morbidity and increase successful outcome of pregnancy. Although clinical literature concerning these sequential syndromes is huge, further studies are needed to understand their underlying pathophysiological pathways across the world.

Objective: Pregnancy a normal physiological condition is worsened by morning sickness, nausea and vomiting of pregnancy, hyperemesis gravidarum, Wernicke’s encephalopathy and Korsakoff syndrome in vulnerable women with gestation. This report of three cases described hyperemesis gravidarum, Wernicke’s encephalopathy and Korsakoff syndrome in the worsening pregnancies. Methods: Prospective collection of data concerning three pregnant patients seen in Dubai Health Care City, Dubai, United Arab Emirates. Results: All three patients were admitted to the hospital with manifestations of HG and WE and one of them showed additional features of Korsakoff syndrome. One patient developed intractable hyponatremia and central pontine myelinolysis. Two patients developed abortion while one patient's pregnancy ended with successful delivery with living infant. All patients were managed with thiamine, antiemetics, parenteral fluids and electrolytes and one patients required steroid therapy. Conclusion: The findings of these cases are compatible with international literature on HG and its sequential syndromes. This study may enhance awareness of HG, WE and KS and also fill the knowledge gap of professionals providing services to women with worsening health during pregnancy in Arabian Gulf countries.

Background: Idiopathic Raynaud’s disease is twice common in women than their counterparts, and secondary Raynaud’s disease co-occurs with a variety of medicosurgical conditions. Both diseases are managed by several medications which are invariably associated with various adverse effects. Objective: This study aimed to describe several standardized SPIRIT and PRISMA steps and items that help in the development of research protocol directed towards systematic review and meta-analysis conduction concerning Raynaud’s phenomenon managed by clinical acupuncture. Methods and Results: Statements, guidelines, list of items and processes related to SPIRIT and PRISMA and their extensions and updated versions are ideal methodological tools in framing Raynaud’s disease and acupuncture research protocols for scientifically conducting not only randomized controlled trials but also systematic review and meta-analysis. By extension, these methodological tools could also be applied to develop research protocols for other diseases and nontraditional treatment interventions with some modifications. A total of 53 studies were included in this study protocol. Discussion: In line with Traditional Chinese Medicine, the pattern of Raynaud’s disease and pros and cons of medical acupuncture should make an important component of discussion, besides the details of included randomized clinical interventions in systematic review and meta-analysis, which are but not limited to treatment effects, their strengths and limitations, quality, heterogeneity and endpoints. Conclusion: The development of research protocol for conducting systematic review and meta-analysis is an art and while framing the draft researchers must take into account various SPIRIT and PRISMA statements and guidelines and their latest versions applicable to various diseases including Raynaud’s phenomenon managed by traditional and modern medications across the world.